Ministry Saint Michael’s Hospital

1. Ministry Saint Michael’s Hospital

2. Baseline Data Purpose: • Proactive approach to infection prevention for those patients having total joint replacement at Ministry Saint Michael’s Hospital (MSMH) • Infection rate for MSMH/Ministry Medical Group is < 1% for FY 2012, but “1 is not zero” • SSI infection incidence for MSMH TKA/THA: • Total 2010 4/285 • Total 2011 4/298 • Total 2012 1/313 (1 – Feb. 2012)* * MSMH/MMG elected to include TSA • Goal: All patients having total joint replacement surgery at MSMH will receive the same level of care (2/2012) Presented at Washington State Hospital Association Safe Table, 7/31/13

3. SSI Prevention Program Initiatives Joint Venture Project – Nov 2011 Multidisciplinary re-design of MSMH joint replacement services encompassing care continuum Standardized pre-op education, maximizing patient involvement Implementation of Joint Replacement Services Coordinator Project JOINTS participation – Feb 2012 Preoperative skin antisepsis (2004) CHG prep expanded to 3 days preop (June 2012) Nasal Culture and decolonization for positive MRSA/MSSA (August 2012) Involvement of Lab, Pharmacy, Business Office in development of process to eliminate patient compliance barriers Expanded SSI Prevention Program – Jan 2013 Inclusion of independent orthopedic group – Dec 2012 All elective joint replacement patients at MSMH receive standardized level of preoperative preparation Presented at Washington State Hospital Association Safe Table, 7/31/13

4. Project JOINTS Participation • Planning Team • Orthopedic Surgeon – MMG clinic • Joint Replacement Services Coordinator - Hospital • Quality Specialist - Hospital • Director of Surgical Services – Hospital • Infection Preventionist - Hospital • Clinic Staff – MMG Clinic • MSMH Administration Presented at Washington State Hospital Association Safe Table, 7/31/13

5. MSMH SSI Prevention Program Participated in IHI Project JOINTS MSMH successfully implemented 3 SSI Bundle Elements: Preoperative skin antisepsis (alcohol prep in OR) 3 days of CHG skin cleansing Nasal swabs - Culture and decolonization of MRSA/MSSA Focus on patient pre-op education and engagement Presented at Washington State Hospital Association Safe Table, 7/31/13

6. Implementation Team Great accomplishment of entire care team • MMG clinic providers/staff • Lab • Pharmacy • SMH surgical services • ASD staff • Central Sterilization • OR crew • Nursing • Environmental services Presented at Washington State Hospital Association Safe Table, 7/31/13

7. Benefits • Provides consistent, best-practice, outcome-focused care • Aligns with our Joint Venture program • Promotes collaboration and standardization Presented at Washington State Hospital Association Safe Table, 7/31/13

8. Obstacles • Different Provider Practice Groups • Patient Compliance • Financial Barriers Presented at Washington State Hospital Association Safe Table, 7/31/13

9. Outcomes Consistently lower infection rate than national average No infections since Feb 2012* Integration of independent practice group Recognized as IHI exemplar hospital for all 3 elements Presented at Washington State Hospital Association Safe Table, 7/31/13

10. Biggest Change • Implementation of culture protocol for MRSA / MSSA • 2012 only MMG providers participating, independents declined • 2013 both Ministry and independent providers at 100% during last three months Presented at Washington State Hospital Association Safe Table, 7/31/13

11. Impact to patients • Improved patient experience • Reduced patient recovery time • Reduced patient charges Presented at Washington State Hospital Association Safe Table, 7/31/13

12. Control Plan Presented at Washington State Hospital Association Safe Table, 7/31/13

13. FY12Q3 FY13Q1 FY13Q2 Presented at Washington State Hospital Association Safe Table, 7/31/13 FY12Q2

14. Summary Why Ministry Saint Michael’s Story? • Demonstrates that even a small facility with limited resources can make a difference • Impact: Lives of 300+ patients per year have been positively affected • Smaller = easier??? • Patient testimonials have been marketing tool with public and with The Joint Commission Presented at Washington State Hospital Association Safe Table, 7/31/13

15. Project JOINTS Implementation Outline • Assemble the right players • Identify Team Champion who “gets it” • Introduction to Project JOINTS materials • Assess your current state • Accent the positive – publicize what you are doing well • Implement changes incrementally • Track results • Report results • Recognize and reinforce positive changes Presented at Washington State Hospital Association Safe Table, 7/31/13

16. Thank you… Questions?

17. Patient Education - Joint VentureMinistry Saint Michael’s Hospital July 31, 2013 Presented at Washington State Hospital Association Safe Table, 7/31/13

18. Preoperative Education Program Patients who have chosen us for their surgeries deserve to have the safest, most efficient, cost-conscious and highest quality experience possible. Our job is to find out what our customers want and work to try and satisfy them, while keeping our responsibilities in mind. Presented at Washington State Hospital Association Safe Table, 7/31/13

19. Charter Key PointsMarch 2011 Opportunity/ Problem Statement: The preadmission clearance process for surgical patients is inconsistent, fragmented, and lacks coordination. This causes errors, omissions, and patient and provider dissatisfaction, duplicative and inefficient staff work and potential cancellations. • Project Goals/Benefits: • Develop and implement astandardized pre-surgical process • Decrease surgery cancellations/delays • Decrease repeat tests • Improve communication Presented at Washington State Hospital Association Safe Table, 7/31/13

20. Patient Education Folder –Accuracy and Consistency • Patient Roadmap • Chronological timeline for patient to follow, identifies critical activities, instructions • Initiated at time of surgery scheduling • Day of Surgery Information • Family information • Establishes reasonable patient expectations • Anesthesia Information • Brief description of types, expected LOS • Map • Procedure specific materials from surgeon Presented at Washington State Hospital Association Safe Table, 7/31/13

21. Sample Pre-op Materials Presented at Washington State Hospital Association Safe Table, 7/31/13

22. Project Results “The new pre-op process will help to more accurately and efficiently bridge the gap between the office visit and day of surgery, ultimately leading to improved satisfaction of all those involved” (Surgeon comment) Presented at Washington State Hospital Association Safe Table, 7/31/13

23. Joint Venture Program • Shawn Dombrowski, RN • Joint Replacement Services Coordinator, MMG • Part of our Joint Venture Project • Implemented December 2011 Presented at Washington State Hospital Association Safe Table, 7/31/13

24. Role of Joint Coordinator • Consistent “face” of the Joint Replacement Program at MSMH • “Navigator” for the patient and family • Information coordinator • Facilitatoror performs home assessment • Preoperative Educator • Inpatient visits • Discharge follow-up contacts • Program evaluation; Celebration picnic Presented at Washington State Hospital Association Safe Table, 7/31/13

25. Sample Joint Venture Materials Presented at Washington State Hospital Association Safe Table, 7/31/13

26. Sample SSI Materials Presented at Washington State Hospital Association Safe Table, 7/31/13

27. Presented at Washington State Hospital Association Safe Table, 7/31/13

28. MSMH Reference Materials * • Updated SSI Prevention Program • Project Timeline • MRSA Culture Protocol • MRSA Patient Education Sheet • CHG Prep and Shower Instruction Sheet • Patient Mupirocin Use Checklist • SSI Prevention Order Sheet *PDF copies have been sent to IHI Presented at Washington State Hospital Association Safe Table, 7/31/13